Background:
The incidence of pregnancy-associated stroke may be increasing. The degree to which this increase is associated with increases in common stroke risk factors is uncertain.
Methods:
We used the National Inpatient Sample (NIS) and National Health and Nutrition Examination Survey (NHANES) to estimate the change between 1999 through 2014 in the prevalence of common stroke risk factors among women 12-45 years of age. These risk factors were hypertensive disorders of pregnancy (gestational hypertension, preeclampsia, or eclampsia), which was ascertained using NIS, and diabetes mellitus, obesity, and smoking, which were ascertained using NHANES. We extracted previously published relative risk estimates for the association between each risk factor and ischemic stroke in pregnant women. Using these estimates, we calculated the attributable risk and expected number of ischemic strokes among pregnant women with each risk factor. We used the NIS to estimate the trend in ischemic strokes documented during a hospitalization for labor and delivery, and modeled trends in such strokes attributable to changes in the prevalence of each stroke risk factor over time.
Results:
The rate of ischemic stroke increased from 7.7 (95% CI, 5.0-10.5) per 100,000 deliveries in 1999-2000 to 12.7 (95% CI, 9.5-15.9) per 100,000 deliveries in 2013-2014 (Fig). Based on changes in the prevalence of hypertensive disorders of pregnancy, diabetes, obesity, and smoking between 1999 and 2014, the expected increase in pregnancy-associated stroke attributable to these risk factors would be approximately 10%, in contrast to the nearly 65% relative increase in strokes documented during pregnancy hospitalizations during this period.
Conclusions:
Changes in the prevalence of common stroke risk factors explain a small fraction of the apparent increase in pregnancy-associated stroke in the U.S. during the past 2 decades.
Effects of Hypertensive Disorders of Pregnancy On The Mortality and Complications in Very Low Birth Weight Neonates
